Evaluating the impact of financial incentives on inequalities in smoking cessation in primary care
Author(s)
Hamilton, Fiona Louise
Type
Thesis
Abstract
Background:
Smoking cessation interventions are underprovided in primary care. This thesis examines the
impact of financial incentives on the provision of smoking cessation interventions, and
inequalities in provision, in primary care.
Methods:
• Systematic review of financial incentives for smoking cessation in healthcare.
• Cross sectional study using general practice data from Wandsworth, London, using
logistic regression to examine associations between ethnicity and disease group with
ascertainment of smoking status and provision of cessation advice following the
introduction of the UK’s Quality and Outcomes Framework (QOF).
• Before-and-after studies using general practice data from Hammersmith & Fulham,
London, looking at the impact of a local financial incentive scheme (QOF+) on
smoking outcomes for patients without smoking-related diseases (primary
prevention), and antenatal patients, using logistic regression to examine inequalities.
Results:
Introduction of financial incentives was associated with increased recording of smoking
status and advice to smokers, most evident for patients with smoking-related diseases
compared with patients without smoking-related diseases, for whom there were much smaller
incentives for recording smoking status and none for offering stop smoking advice. However, when specific incentives were provided for primary prevention large improvements in
smoking outcomes were seen.
The youngest and oldest groups of patients were less likely to be asked about smoking. White
British patients were more likely to smoke than other ethnic groups, except Black Caribbean
men with depression, 62% of whom smoked. Smoking advice was provided relatively
equitably, but Black Caribbean men with depression were less likely to receive advice than
White British men with depression (59% vs 81%). Disparities in smoking outcomes with
respect to age and ethnicity persisted after the financial incentives were introduced.
Conclusions:
Introduction of financial incentives was associated with increases in recording smoking status
and largely equitable provision of cessation advice, but variations in smoking outcomes
between groups persisted. Extending financial incentives to include recording of ethnicity
and rewarding quit rates may further improve smoking outcomes in primary care.
Smoking cessation interventions are underprovided in primary care. This thesis examines the
impact of financial incentives on the provision of smoking cessation interventions, and
inequalities in provision, in primary care.
Methods:
• Systematic review of financial incentives for smoking cessation in healthcare.
• Cross sectional study using general practice data from Wandsworth, London, using
logistic regression to examine associations between ethnicity and disease group with
ascertainment of smoking status and provision of cessation advice following the
introduction of the UK’s Quality and Outcomes Framework (QOF).
• Before-and-after studies using general practice data from Hammersmith & Fulham,
London, looking at the impact of a local financial incentive scheme (QOF+) on
smoking outcomes for patients without smoking-related diseases (primary
prevention), and antenatal patients, using logistic regression to examine inequalities.
Results:
Introduction of financial incentives was associated with increased recording of smoking
status and advice to smokers, most evident for patients with smoking-related diseases
compared with patients without smoking-related diseases, for whom there were much smaller
incentives for recording smoking status and none for offering stop smoking advice. However, when specific incentives were provided for primary prevention large improvements in
smoking outcomes were seen.
The youngest and oldest groups of patients were less likely to be asked about smoking. White
British patients were more likely to smoke than other ethnic groups, except Black Caribbean
men with depression, 62% of whom smoked. Smoking advice was provided relatively
equitably, but Black Caribbean men with depression were less likely to receive advice than
White British men with depression (59% vs 81%). Disparities in smoking outcomes with
respect to age and ethnicity persisted after the financial incentives were introduced.
Conclusions:
Introduction of financial incentives was associated with increases in recording smoking status
and largely equitable provision of cessation advice, but variations in smoking outcomes
between groups persisted. Extending financial incentives to include recording of ethnicity
and rewarding quit rates may further improve smoking outcomes in primary care.
Version
Open Access
Date Issued
2013-03
Date Awarded
2013-07
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Majeed, Azeem
Millett, Christopher
Sponsor
Collaboration for Leadership in Applied Health Research and Care (Great Britain) ; Imperial College London
Publisher Department
School of Public Health
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)